Submitted by: Krishan B Kumar

From the foregoing information on UTI, one should realize that the best course is to follow, strictly, the preventive measures, which are very simple, mostly relating to routine hygiene, rather than being on long-term prophylactic antibiotks; or, in neglected cases, developing terminal kidney disease, i.e. kidney failure, which may, require repeated dialysis, or even kidney transplant, depending on the case.

Various guidelines are mentioned below, and all individuals, irrespective of age and sex, are required to carefully follow them in their everyday life.

(i) Perineal hygiene

The perineum is the area where the openings of the anus, the urethra and the vagina are situated (of course, the scrotum and the penis in the male). It is the most dangerous area, especially in females, as all the three openings are lying close together (Fig. 21), and there is always a threat of infection to the urinary tract from anal-faecal organisms, which invade the urinary tract through the urethral opening. Hence if proper hygiene is maintained after each defecation, the infection from the anus to the urethra can be stopped/prevented since UTI is caused mostly by E. coli organisms present in the faeces. Of course, the various predisposing/associated factors responsible for UTI, if present, have to be simultaneously investigated and treated.

A simple cleansing with water, and preferably with soap and water after passing stools, and urine in the case of females, is strongly recommended at all ages, more so in children, girls, both married and unmarried women. However, those using toilet-paper, after passing stools, should be more careful, and see that the area has been thoroughly cleaned, especially in the case of females. Hence, it is of the utmost importance to always keep the perineal area clean, and thus it has been rightly said that ‘cleanliness is next to godliness.’

(ii) Passing of ur’ine after sexual intercourse (postcoital voiding) Since during sexual activity, the organisms may gain entry through the urethral opening into the urinary bladder, it is advisable for all women to pass urine after each sexual intercourse, so that the bacteria, in case they have entered the urinary bladder, are washed out. It is safer if urine is also passed before sexual intercourse.

Further, women who are more prone to UTI, or get recurrences of UTI as a result of intercourse, are advised to take a single dose of prophylactic broad-spectrum antibiotic like norfloxacin, ciprofloxacin, lomefloxacin or ofloxacin, etc., after sexual intercourse/ coitus. This is an important step in the prevention of UTI in such patients, and has shown promising results..

The above step for the prevention of UTI is very important and calls for an urgent need to impart sex education at the appropria te age. Physicians / obstetricians / gynaecologists / paediatricians can also guide their patients as and when an opportunity arises. Mothers can also advise their children in this matter.

(iii) Passing of urine frequently

All persons, and especially those who are more prone to UTI, should pass urine frequently, say every 3-4 hours, so that the urinary bladder is constantly washed out, and the bacteria, if any, are pushed out in the urine. If the bladder is not evacuated frequently, the bacteria will get more time to increase in number in the urine collected in the urinary bladder. Hence, frequent urination is an esseI)tial step towards the prevention of UTI, which should be observed by everyone.

In any case, urination should not be postponed, as this will increase the rise of UTI.

(iv) Passing of urine at bedtime

Similarly, urine must be passed at bedtime, so that the minimum quantity of urine remains in the urinary bladder during the night. Since the duration of the night is long, there should be as little urine as possible in the bladder, and one should pass urine even during the night, if he or she happens to wake up.

(v) Plenty of fluids

It is obvious that the intake of plenty of fluids is required, so that there is frequent urination, and the bladder is constantly kept clean. At least about three litres of water/fluids must be taken daily to achieve the desired results.

Ideally, the habit of frequent urination or bladder training, including cleanliness, should be instilled right from childhood, especially in the case of female children. Above all, once the subject is made clear to the sufferers/others, it becomes routine.

(vi) Immediate treatment of predisposing factors

As soon as some predisposing/ obstructive lesions happen to occur, e.g. urinary stones, benign enlargement of prostate, etc., immediate attention should be paid, and surgery, if required, should not be delayed, so that UTI does not develop at all, and there is absolute prevention.

(vii) Control of high blood pressure and diabetes

Control of high blood pressure and diabetes is an essential requirement to prevent the kidneys from contracting an infection, since a damaged kidney, as a result of high blood pressure and/or high blood sugar, is always prone to get infection. The infection in such kidneys can only be avoided/ prevented if it is protected from damage by these diseases. That is, a strict control of both high blood pressure and diabetes is required. This aspect has also been emphasized earlier.

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